MEDICARE: PINELLAS NURSING HOME PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME77230	FL

General Provider Information

NPI Number	:	1083069272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINELLAS NURSING HOME PA

Provider Business Mailing Address
First Line	:	2595 TAMPA RD STE D
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3130
Country	:	US
Telephone Number	:	727-773-8884
Fax Number	:	727-784-5449

Provider Business Practice Location Address
First Line	:	2595 TAMPA RD STE D
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3130
Country	:	US
Telephone Number	:	727-773-8884
Fax Number	:	727-784-5449

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. PANKAJ K JOSHI
Credential	:	M.D.
Telephone Number	:	727-773-8884

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	04/26/2016

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